Boorman Rhonda J, Devilly Grant J, Gamble Jenny, Creedy Debra K, Fenwick Jennifer
School of Applied Psychology & Griffith Health Institute, Griffith University, Mt Gravatt, Qld 4122, Australia.
School of Nursing and Midwifery & Maternity and Family Unit, Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Logan, Qld 4131, Australia.
Midwifery. 2014 Feb;30(2):255-61. doi: 10.1016/j.midw.2013.03.001. Epub 2013 Apr 26.
for some women childbirth is physically and psychologically traumatic and meets Criterion A1 (threat) and A2 (intense emotional response) for Posttraumatic Stress Disorder of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV).This study differentiates Criterion A1 and A2 to explore their individual relationship to prevalence rates for posttraumatic stress, each other, and associated factors for childbirth trauma.
women were recruited at three hospitals from October 2008 to October 2009. Questionnaires were completed at recruitment and at 14 days post partum.
women in the third trimester of pregnancy (n=890) were recruited by a research midwife while waiting for their antenatal clinic appointment. Participants were over 17 years of age, expected to give birth to a live infant, not undergoing psychological treatment, and able to complete questionnaires in English.
this study found 14.3% of women met criteria for a traumatic childbirth. When the condition of A2 was removed, the prevalence rate doubled to 29.4%. Approximately half the women who perceived threat in childbirth did not have an intense negative emotional response. Predictors of finding childbirth traumatic were pre-existing psychiatric morbidity, being a first time mother and experiencing an emergency caesarean section.
the fear response is an important diagnostic criterion for assessing psychologically traumatic childbirth. The identification of risk factors may inform maternity service delivery to prevent traumatic birth and postpartum approaches to care to address long-term negative consequences.
prevention and treatment of traumatic childbirth are improved through knowledge of potential risk factors and understanding the woman's subjective experience.
对一些女性而言，分娩在生理和心理上具有创伤性，符合《精神疾病诊断与统计手册》第四版（DSM-IV）中创伤后应激障碍的A1（威胁）和A2（强烈情绪反应）标准。本研究区分A1和A2标准，以探讨它们与创伤后应激患病率、彼此之间以及分娩创伤相关因素的个体关系。
2008年10月至2009年10月期间，在三家医院招募女性。在招募时和产后14天完成问卷调查。
由一名研究助产士在孕妇等待产前门诊预约时招募妊娠晚期女性（n = 890）。参与者年龄超过17岁，预计分娩活婴，未接受心理治疗，且能够用英语完成问卷。
本研究发现14.3%的女性符合创伤性分娩标准。去除A2条件后，患病率翻倍至29.4%。约一半在分娩中感知到威胁的女性没有强烈的负面情绪反应。分娩具有创伤性的预测因素是既往有精神疾病、初产妇以及经历紧急剖宫产。
恐惧反应是评估心理创伤性分娩的重要诊断标准。识别风险因素可为产科服务提供参考，以预防创伤性分娩以及采取产后护理措施来解决长期负面后果。
通过了解潜在风险因素并理解女性的主观体验，可改善创伤性分娩的预防和治疗。
